Plan Management Express Sign-up Form

Thank you for choosing us and signing up for your Plan Management Service.

To get started simply fill on the form below. Please note all fields marked with an asterisk (*) require an answer to continue.

If you need help completing this form, please contact us on 1300 946 337.

If Plan Management is already included in your NDIS plan, then there is no cost to you when you use NDIS Plan Management services.

Please read and ensure you understand our Privacy Policy here before completing this form.

By filling out this form, you are selecting Windermere as your NDIS Plan Manager

Thank you and we look forward to working with you and taking the stress out of managing your NDIS plan.

Are you signing up: *

For yourselfAs Parent / CarerAs Referrer / Other (Please specify)

Please select the most appropriate: *

Organisation name: *

Referrer first name: *

Referrer last name: *

First name: *

Last name: *

Please select suburb & postcode: *

Do you have consumer consent or NDIS authority to share the participant’s information? *

YesNo

Which of the below applies to you: *

The NDIS participant is under 18, and I am their legal guardianThe NDIS participant is over 18, and I have their consent or am their legally appointed representative None of the above

Unfortunately, you cannot sign up on behalf of a participant without their consent. Please fill out our enquiry form instead and our team will be in touch to confirm next steps. Access our Plan Management Enquiry Form here.

Contact Details

Primary contact details

If you are the contact person for this NDIS Participant, please check this box. Otherwise, please provide the best contact person details.

Please provide your details below, or alternatively the best person to contact.

Contact person first name: *

Contact person last name: *

Relationship to NDIS participant: *

Contact person first name: *

Contact person last name: *

Relationship to NDIS participant: *

NDIS participant details

NDIS participant first name: *

NDIS participant last name: *

NDIS participant suburb & postcode: *

NDIS Plan Details

NDIS number *Your NDIS number is the 9-digit reference number located in the top left of your NDIS Plan

NDIS plan start date *

NDIS plan end date *

Is the NDIS participant new to Plan Management? *

YesNo

Are you new to Plan Management *

YesNo

Does the NDIS participant currently have a plan manager that they are looking to change from? *

YesNo

Do you currently have a plan manager that you are looking to change from? *

YesNo

Who is the NDIS participants current plan manager?

Who is your current plan manager?

Do you need a free and confidential interpreter? *

YesNo Interpreter Required

If you answered yes to above, which language do you need help with? *

Preferred method of contact: *

Phone NumberEmail Address

Email address: *

Phone number: *

Alternative phone number:

Please enter a home phone number with a 2-digit area code or a mobile number without any spaces. E.g. 0409506428 or 0387941333

Preferred contact time: *

AMPMAnytime

How did you find us? *

Please specify: *

Other notes:

Thank you for completing this form. If you are not the contact person but wish to know the referral outcome, please include your contact details in the comment box above.

Windermere takes your privacy seriously. We have policies and safeguards in place that comply with the Privacy Act 1988 (Commonwealth), the Privacy and Data Protection Act 2014 (Vic), and the Health Records Act 2001 (Vic).

For more information on how we protect your privacy, click this safe link Privacy Policy | Windermere

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